Mandatory Sleep Apnea Screening for Everyone?

This is an incredible story, but unfortunately, it probably happens more often than you think. The NTSB (National Transportation and Safety Board) recently investigated a Hawaiian airline incident where both pilots fell asleep and missed their destination by 18 minutes. Air traffic control was able to wake up the pilots, who turned around and landed the passenger plane safely. The captain was later diagnosed with obstructive sleep apnea.

 

There are numerous other reports of train, bus and tracker trailer accidents, many of them fatal due to the driver having suspected obstructive sleep apnea.

 

After a long investigation, the NTSB recommended that all long-distance truckers, airline pilots, bus drivers, merchant ship pilots, and train operators should be screened for obstructive sleep apnea. This is a step in the right direction, but what about the rest of the population? 

 

It’s been estimated that  24% of middle aged men and 9% of women have at least mild sleep apnea. This is one of the most often cited statistics from 1993. I would think that with the obesity epidemic, the numbers are now much higher. A recent study looking at active independent seniors (ages 71-87) showed that 55% had significant sleep apnea. These numbers are much higher for seniors that are hospitalized. 

 

You don’t have to be a commercial pilot, truck or bus driver to be at risk for sleep apnea. Everyone is at risk. If you have untreated sleep apnea, you are over 6 times more likely to get into an accident. Your reaction times are worse than being legally drunk. Snoring alone alone without sleep apnea also increased your risk by 300%. 

 

Truckers will argue that most commercial accidents are caused by passenger vehicles. All it takes is one sleepy passenger car driver to cause a major bus accident. 

 

Interestingly, another study showed that snoring men with daytime sleepiness or witnessed apneas drive more than others. It’s a scary thought. What they’re probably doing is to choose an activity where sustained vigilance is needed, but unintentionally, they are placing themselves and others at increased risk.

 

I admit that there are logistical and financial implications to putting into place a universal screening program for sleep apnea. Besides the costs alone, what do we do with people who can’t drive the bus or work at all while waiting to be cleared? What about all the people who can’t tolerate any of the treatment options? Do they go on disability? Do they have to switch to other careers? 

 

On the other hand, the potential benefits are enormous. Treating the remaining 90% of undiagnosed sleep apnea patients will significantly lower the cost of providing healthcare since it’ll prevent or significantly lessen the severity of many medical conditions such as hypertension, diabetes, obesity and cardiovascular disease.

 

Given all these issues, what do you think about universal screening? Please respond with your comments in the box below.

 

Please note: I reserve the right to delete comments that are offensive or off-topic.

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8 thoughts on “Mandatory Sleep Apnea Screening for Everyone?

  1. Great post! It is very frightening to think that pilots and truck drivers are so tired( many of them from sleep apnea) that they put thier own lives in peril plus countless others.
    David

  2. We regularly check our weight, cholesterol levels, blood pressure, and blood sugar looking for problems. Why don’t we regularly screen for sleep-disordered breathing (SDB) which is the source of the other problems? Let’s diagnose and treat the root cause. Screening should become a routine part of medical and dental exams.

    We do need a new treatment (or better yet, a cure) for sleep apnea. CPAP is a difficult process to implement properly and there are also many problems trying to sleep with dental appliances.

  3. There are a number of simple questionnaire-based screening tests that are simple and cost nothing to administer. People at high risk can then undergo formal testing. Now the question is, do we send all these people for overnight studies, or in-home studies? Ultimately, economic factors will probably prevail over clinical issues.

  4. “Now the question is, do we send all these people for overnight studies, or in-home studies? Ultimately, economic factors will probably prevail over clinical issues.”

    IMO, the economic issues are huge due to the high prevalence of sleep apnea. What about some effective shortcuts? I suggest a questionnaire-based screening test specifically targeting the obstructive type of sleep apnea. Combine this with a physical examination of jaw structure looking for lack of depth, narrowness and poor mandibular advancement. Now identify the patient as high risk for obstructive sleep apnea and send him home with an inexpensive pulse-oximeter device.

    If the patient exhibits oxygen desaturations typical of obstructive sleep apnea, then prescribe an APAP set to pressure of 7 – 20 cm. Provide support and education to perform a self-titration using data from the APAP.

    This idea needs some development, but I am sure we can’t afford the typical two nights in a sleep lab and we also can’t afford to leave such a large portion of our population untreated.

  5. I agree. We have the resources and the knowledge to have a low-cost screening process on a large scale. Studies have shown that treating sleep apnea saves a lot more health care collars in the long run. I wonder if the politicians debating our health care policies ever considered undiagnosed obstructive sleep apnea as a major public health problem.

    There are a number of excellent screening tests that combine a few simple questionnaires and physical exam findings. You can either send these patients home with O2 monitors or go straight to APAPs. The hard part will be all the support and follow-up that’s needed to make sure all these additional people can benefit from treatment or go to something else if they can’t tolerate CPAP.

    This is just a personal observation, but in recent memory, every airline pilot, bus driver or train operator that I’ve treated seems to have adapted to using CPAP relatively easily, as opposed to people in other occupations that don’t require driving or flying. I wonder if your job is on the line, you’ll be more likely to make the effort to get treated and cleared quickly so you can go back to work.

  6. i concur with the above coments and add that a tranport system be in place and that employment nom should be local if posible walking distants the same with schools they should be in walking distants, shops etc so that the is less reliance on transport in the future